In Reply.—I am not sure what question Dr Özsoylu is raising about the diagnostic criteria of otitis media that Dr Schwartz and I used. He cited a study1 in which the description of the otoscopic findings was limited to (1) thick and reddened, (2) bulging, or (3) perforated. The group of children studied in the Netherlands1 all were seen by general practitioners, and all were 2 years of age or older, which would exclude 39% of the patients with otitis media seen by Dr Schwartz in his private practice. Because of the lack of definition of otoscopic findings in otitis media and nonuse of the pneumatic otoscope in this study,1 I think that the number of patients, detected by general practitioners, 2 years of age and older without pneumatic otoscopy would not correspond at all to the detection of otitis media in children of all ages with
HOWIE VM. Acute Otitis Media-Reply. Am J Dis Child. 1983;137(12):1213. doi:10.1001/archpedi.1983.02140380071032
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